There is a demonstrated connection between menstruation and seizures in women with simple partial, complex partial and generalized tonic-clonic seizures.

Different types of seizures are associated with different phases of a woman’s menstrual cycle.

• absence seizures – more seizures during days 16 to 28 of the average menstrual cycle and the least seizures during periods
• partial seizures – fewer seizures during days 16 to 28 and more seizures just prior to ovulation and during periods

Women with epilepsy (especially those who have complex partial seizures) have reported menstrual disorders such as:

• amenorrhea – absence of menstruation
• oligomenorrhea – scanty menstruation
• cycles of irregular length and
• absence of changes in cervical mucus.

Anticonvulsant medication can further aggravate mood swings, often pronounced prior to and during menstruation. If mood swings become problematic, women should discuss adjustments to medication with their physicians.

Epilepsy is seldom an hereditary condition and does not impair the normal development of intelligence and personality. There are exceptions in a very small number of cases in which certain brain wave patterns are associated with a particular seizure type. Physicians may suggest genetic testing if pertinent.

If one parent has this type of genetic epilepsy, the child has about a 10 per cent chance of developing epilepsy. (Children of parents who do not have epilepsy have a 1 to 2 per cent chance of developing epilepsy at some point in their lives.)

If both parents have epilepsy that is hereditary in nature, the child has a 25 per cent of developing epilepsy. It is reassuring to note that even if a child does inherit this type of epilepsy, medication often controls the seizures very successfully.

By the Numbers

Why do seizures change during pregnancy?

Important

It is natural for women to be concerned about the effect of seizures on the fetus. Most studies indicates the number of seizures during pregnancy has little effect on the baby except in rare cases of uncontrolled multiple seizures – status epilepticus.

Status epilepticus is life-threatening both to the mother and the baby. It is a serious medical emergency.

Women with epilepsy are considered to have high risk pregnancies. High risk indicates an increased likelihood of greater-than-average risks to the mother and/or the fetus. There are several complications that occur more often to women with epilepsy.

Eclampsia

Placental Problems

The birth of a “normal” baby without birth defects is a primary concern for all parents. Since all drugs present a possible danger to a developing fetus, it is understandable for a woman to be concerned about the effects of her anticonvulsant medication on her baby.

By the Numbers

Types of Birth Defects

Important

Upon becoming pregnant, a woman may be tempted to stop taking medication to protect the baby from side effects. The repercussions of abruptly changing medication intake can be life threatening. Withdrawing medication can cause prolonged seizures (five minutes or longer), which deprives the fetus of oxygen.

Stopping medication in this way poses a risk greater than the effects of the drugs themselves.

Certain anticonvulsants deplete the body of folic acid, an important vitamin that a fetus needs to develop. In partnership with a physician, a woman with epilepsy should ensure her diet is adequately supplied with folic acid.

A shortage of zinc because of anticonvulsants can cause fetal malformations including cleft palates. Because zinc deficiency is not physically obvious, a pregnant woman should have intensive nutritional counselling prior to and during pregnancy. Depending on the advice of a nutritionist, supplements up to twice the normal daily requirement could be recommended safely.

A unique bleeding problem in babies whose mothers take anticonvulsants may occur usually in the first 24 hours after birth. mothers can prevent this by taking vitamin K orally during the last two weeks of pregnancy. The regular dosage of vitamin K routinely given to the baby will not be adequate to prevent this phenomenon.

Labour itself will not precipitate a seizure. During labour, however, a woman may miss doses of anticonvulsants. Because certain anticonvulsants have shorter half lives, a woman could have low levels of anticonvulsant medication in her system during labour. This puts her at greater risk of a seizure.

A woman should consult her physician during prenatal visits about taking medication during labour.

Research indicates that babies do not suffer any harmful effects from traces of anticonvulsant medication found in breastmilk. The physiological and psychological benefits of breastfeeding to the mother and child are significant. If a woman wishes to breastfeed, she should be encouraged to do so.  She should discuss any concerns she has with a physician during prenatal visits.

Babies who are bottle fed may experience temporary withdrawal symptoms such as tremors and agitation. This is a natural reaction as the babies are no longer receiving the amount of anticonvulsant medication they received in utero.

1. When bathing a baby, it is preferable to wash the baby on a mat in the crib, with a bowl of water outside the crib. If you are alone, a baby should not be bathed in an adult or baby bath.
2. A well-padded easy chair is a safe, comfortable place to breast- or bottle-feed a baby. If a rocking chair is used, pad the arms with towels and use extra pillows to cushion the child. The mother can also lie on her side to feed the baby.
3. Ensure there is a portable crib or playpen on each level of the home.
4. Make sure medications are safely locked away, out of a young child’s reach. When the child can understand, explain why you take the medication and tell him/her about any seizure you may have. Children can learn to help you and help care for younger siblings during a seizure.
5. Secure an outside play area with a sturdy fence and a locked gate. If taking a young child for a walk in a stroller, attach a safety harness to the child. Discreetly affix a tag or sticker on the stroller with the baby’s name and the name of a relative or emergency caregiver to contact in the event of a seizure. If taking a toddler for a walk without a stroller, continue to use a wrist harness until the child is old enough to fully understand that s/he must stay close to you if you have a seizure.

If possible, inform neighbours of your seizure disorder, describing what they can do to assist you should the need arise. Post emergency phone numbers in a prominent location where neighbours or your children can obtain them quickly.

Many women with epilepsy feel vulnerable, especially when they have the additional responsibility of caring for children. Specially-trained service dogs can provide invaluable assistance and protection.